“Alternative Medicine” isn’t

I am not Orac (though at times I wish I had his flair and his work ethic). My involvement in medicine can be accurately described as “tangential”, at least insofar as it comes to my career. That being said, I’m interested in the decisions we make when the stakes are high, and they don’t get much higher than the life and death circumstances we find ourselves in when talking about our health. As a result, I am acutely interested in the discussion around “alternative” medicines.

Alternative medicine, of course, is a propaganda phrase used to describe “treatments” that lie outside of the accepted norms for medicine. It is applied with equal gusto to completely sensible and useful things like modifying diet and exercise; things that seem like they might work but are a little out there like acupuncture and chiropractic; and to things that don’t make any sense and are completely batshit insane like homeopathy or energy healing (although, to be sure, there are way crazier things out there). The problem with such a… shall we say… flexibile definition of “alternative”, is that when someone points out that acupuncture doesn’t work, or that “energy healing” is the same fakery that faith healers exploit, people jump on them and say that they’re against anything that is “natural”.

That’s a distortion of the skeptical position that is so outrageous that it borders on being a lie. Large mainstream science-based organizations like Health Canada and the World Health Organization whole-heartedly endorse the use of diet and exercise modification to reduce the risk of heart disease, diabetes, stroke, and any number of other chronic and acute conditions. Herbal remedies are refined and turned into powerful pharmaceuticals (Aspirin is a commonly-invoked example of such a refinement). Things like yoga, massage, and other types of relaxation therapy are often recommended to reduce stress which can underly a number of health problems. Skeptics are happy to accept something so long as it works. We don’t care if it’s “alternative” or not.

These “alternative medicines” are not alternative in any way – if they work, then they aren’t alternative, they’re just medicine. The other side of the problem is the ones that are truly “alternative” aren’t medicine! They don’t work any better than voodoo or augury or invoking ancestor’s spirits. This wouldn’t be so problematic, except that they still do cause side-effects:

Giving alternative treatments such as homeopathic remedies instead of conventional medicines to children may have deadly side-effects in rare instances, a new analysis says. Australian researchers monitored reports from pediatricians in Australia from 2001 to 2003 looking for suspected side-effects from alternative medicines like herbal treatments, vitamin supplements or naturopathic pills. They found 39 reports of side-effects including four deaths.

Real medicine is regulated, monitored for safety, and must pass through a strict certification process to reach market. Nobody would claim that the process is perfect – some real stinkers get through – but they get caught. All some quack has to do is slap the label “alternative” on her product, and she gets off scot free. This poses a real threat – herbs and supplements are biochemically active substances that have real effects in the body. The liver doesn’t care if something is “natural” or not – it still breaks it down. The metabolites of any substance that enters the body can exert real effects, particularly if they are used in conjunction with pharmaceuticals.

But what about things like reiki or homeopathy? Surely these things that exert no actual effect on the body (above the often-misunderstood placebo effect) don’t cause the liver to do anything. What possible side-effects could they cause?

In 30 cases, the issues were “probably or definitely” related to complementary medicine, and in 17 the patient was regarded as being harmed by a failure to use conventional medicine. The report says that all four deaths resulted from a failure to use conventional medicine.

One death involved an eight-month-old baby admitted to hospital “with malnutrition and septic shock following naturopathic treatment with a rice milk diet from the age of three months for ‘congestion'”. “Another death involved a 10-month-old infant who presented with septic shock following treatment with homeopathic medicines and dietary restriction for chronic eczema,” the authors say.

One child had multiple seizures after complementary and alternative medicines (CAMs) were used instead of anti-seizure drugs due to concerns about potential side effects. The fourth death was of a child who needed blood-clotting drugs but was given complementary medicine instead.

These people proceeded in defiance of medical advice to give useless products to children with real health problems. Adults do this to themselves too. It’s not because they didn’t know or weren’t told, it’s because they believed in the lie that is the phrase “alternative medicine”. I can’t put too strong a point on this: “alternative medicine” isn’t alternative, and it isn’t medicine. The stuff that works is just medicine, and the stuff that doesn’t work is nothing other than voodoo.

I have friends who are voodoo practitioners. A woman I did my undergraduate with is training to be a chiropractor (much to the face-palming chagrin of the rest of our class); two of my close companions here in Vancouver use acupuncture as part of their otherwise science-based rehabilitative toolkit; another friend is into “energy work”, whatever that means. This is not an abstract concept to me, nor should it be to you. If you buy into the idea that there is such a thing as “alternative medicine”, you’re helping contribute to the climate that puts completely decent things like healthy lifestyle factors in the same category as crystals and “psychic surgery”.

There is no “alternative medicine” – there’s just medicine and bullshit.

The problem comes into play when your employers or your clients mention the “energy work”- if they ask specifically about it, I can respond. Unfortunately, there are so many crazies in the field that its simply assumed I am one- do I correct them or just smile and nod?

This is why I work largely for myself and on word-of-mouth referred clients.

The stereotypes I run into when I admit my profession is just… face-palm worthy at times. Not all massage therapists believe in chiropractics, “medical” massages, reiki, lights, aromas, crystals, energy, chi, mini-black-holes, “holistic” and “alternative” philosophies, yet, people will assume that I not only believe but practice them all.

In reading your most recent comment, I think you and Paul are definitely on the same page.

With regards your conundrum (i.e. what to say), I have a paper on that topic that I’m trying to get published. And while I think there are significant practical concerns (one needs to eat, to live, and to gain an income in order to facilitate those things), I think there is an ethical obligation to standing up in the face of bullshit and unequivocally calling it out.

Which, let’s face it, is all well and good for me to say as I’m not trying to earn a living in that field…

According to Paul, however, you are not alone. And as there are therapists looking to live a bullshit-light life, so are there clients.